Suicide prevention and serotonergic drugs

Clinical management of deliberate self-harm in young people: the need for evidence-based approaches to reduce repetition

OBJECTIVE

To examine the evidence for the effectiveness of clinical interventions designed to reduce the repetition of deliberate self-harm (DSH) in adolescents and young adults.

METHODS

Electronic databases were searched for papers describing randomised and clinical control trials (RCTs) and quasi-experimental studies of interventions targeting adolescents and young adults presenting to clinical services following DSH or suicidal ideation.

RESULTS

Three RCTs, four clinical control trials and three quasi-experimental studies were identified. Group therapy, trialled in a RCT, was the only specific programme which led to a significant reduction in rates of repetition of self-harm. Attendance at follow-up did not improve significantly regardless of the intervention, while one clinically controlled trial of intensive intervention resulted in poorer attendance at follow-up. One quasi-experimental study of family therapy resulted in a significant reduction in suicidal ideation.

CONCLUSIONS

The evidence base for treatments designed to reduce the repetition of self-harm in adolescents and young adults is very limited. Expensive interventions such as intensive aftercare offer no clear benefit over routine aftercare. Given that deliberate self-harm among young people is a common clinical problem further good quality treatment studies are warranted. Careful consideration should be given to process evaluation to determine which individual components of any given intervention are effective.

Suicide prevention in late life: directions for science and practice

Suicide among the elderly is a critical public health problem, yet there remains limited information on risk factors to target due to the few number of controlled studies that could help isolate and focus on the most potent risk factors. We suggest that because there are no proven, effective interventions showing reduced suicidal behaviors in older adults, the best current approach is to improve detection and treatment of later-life depression. This effort may be especially effective in primary care settings, where the majority of our nation's elderly seek and receive their mental health care. We review approaches to assessment and treatment of later life depression that seem most relevant for later life suicide prevention. Testing and determining whether these treatment approaches are effective is an immediate goal on the path to advancing the science and practice of late-life suicide prevention.

Suicide and violence assessment in psychiatry

Psychiatrists are increasingly expected to predict and prevent the suicidal and violent/homicidal impulses of their clients. This article reviews the current literature and research in these areas. While the debate continues on whether the clinician can successfully predict either violence or suicidal behavior in their patients, the preponderance of studies weighs in that predicting suicide and violence in the individual may not be possible currently given present knowledge. To compensate for forecasting limitations, conservative clinicians deliberately overpredict suicide or violence to help insure the safety of their patients and the greater communities in which they reside. In addition, clinicians need to perform thorough assessments and make logical clinical decisions that are in line with the perceived risks. Preventive measures for violence remain complex, but clinicians can maximize treatment effects by following specific intervention guidelines. Minimally, documentation concerning violence needs to focus on the rationale for why treatment interventions were or were not implemented. The chart does not require lengthy notations but should include a reasonable assessment of risk and the delineation of a prudent course of action.